Insurance Customer Service Specialist I

Forest County Potawatomi

POSITION TITLE: Insurance Customer Service Specialist I
SUPERVISOR: Insurance Administration Manager

Position Summary:

Under the general supervision of the Insurance Administration Manager, this is a multitasking, timeline directed, customer service driven position that provides the ground work for all Insurance team functions. The ideal candidate for this position must be self-directed, organized, energetic, and service oriented with a professional manner, work well under pressure and is comfortable with diverse cultures.

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities:

  • Re-price Contract Health Services/ Purchased Referred Care eligible claims to the Medicare Like Rates for hospital and physicians for both internal and external clients.
  • Request CMS negotiated Medicare Like Rate documentation from hospitals and providers as needed
  • Maintain database of facility CMS Rate Notifications letters and submit to data vendor as needed to ensure accurate re-pricing
  • Update and maintain Section 506 Recovery reimbursement data via excel spreadsheets
  • Prepare and compile documents for stop-loss and Catastrophic Health Emergency Fund reimbursements
  • Update and input pre-certifications and authorizations into claim adjudication system
  • Re-price employee health claims in their designated Preferred Provider Organization (PPO) software portal
  • Manage paper documents for electronic workflow, scanning and indexing
  • Identify documents for destruction, maintain destruction schedule and verify documents are destroyed on site by document destruction vendor
  • Must obtain and maintain HIPAA certification
  • Assist walk-in customers promptly and courteously
  • Identifies and assesses customers’ needs to achieve satisfaction
  • Manages incoming customer service calls and inquiries
  • Manage departmental mail posting, sorting and distribution
  • Assist Accounting Specialist with in-house check runs
  • Create departmental purchasing requisitions for the Director’s approval
  • Type letters, reports, memos and create flyers as requested by supervisor
  • Maintain office business equipment
  • Print and distribute daily reports and all letters generated by claims examiners
  • Assist in the production and distribution of benefit information to members employees and clients
  • Maintain office supply inventory
  • Serves as the Emergency Management Representative for the Insurance Departmen
  • Obtain and maintain necessary certification for Insurance Marketplace CAC
  • Maintain strict confidentiality
  • Performs other duties as required.

Minimum Qualifications:

  • High school diploma or GED
  • Four years of work experience in a medical office, medical facility, health insurance or employee benefits preferred
  • Experience with Indian Health Service preferred
  • Successfully pass a background check and pre-employment drug screening.

Knowledge, Skills, and Abilities:

  • Excellent computer skills including expertise with Word, Outlook, PowerPoint and/or Excel
  • Knowledge of medical terminology
  • Health/medical insurance literate
  • Ten-key proficient
  • Ability to multi-task
  • Ability to work without supervision
  • Ability to work with shared responsibilities
  • Ability to meet timelines
  • Friendly and comfortable with greeting customers
  • Able and willing to work within a team setting
  • Excellent attendance
  • Must be honest, trustworthy and reliable.

Physical Demands:

While performing the duties of this job, the employee regularly is required to stand, sit, use hands to finger, handle or feel; talk or hear. The employee frequently is required to walk and reach with hands and arms.  The employee occasionally is required to climb or balance and stoop, kneel, crouch or crawl.  The employee must occasionally lift and/or move up to 25 pounds.

Work Environment:

Work is generally performed in an office setting with a moderate noise level.  Evening and/or weekend work may be required.  Extended hours and irregular shifts may be required.


As authorized by federal law, Forest County Potawatomi Community reserves the right to exercise preference in hiring for qualified Tribal members/Indians in connection with all positions and job openings.



POSTED:     8-7-18

CLOSING:   8-21-18

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